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Contact Information

BRENNA M SHACKELFORD, MD
520 S EAGLE RD STE 3102
MERIDIAN, ID83642-6352
 Phone: 208-381-1615
 Fax: 208-381-5141
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Hospice and Palliative Medicine

207PH0002X 17 Physician/Hospice and Palliative Care
 

Emergency Medicine

207P00000X 93 Physician/Emergency Medicine
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for BRENNA M SHACKELFORD · (Female)

NPI # 1033377833
Status Active
Credentials MD
Entity Individual
Enumeration date 05/28/2008
Last updated 08/06/2024 - More than a year ago
Sole proprietor 1 No
Identifiers
  • CA License # A133488
  • HI License # MD19340
  • ID License # M-15461
  • ID License # M15461
  • IN License # 01067626A
  • NV License # 23824
Hospital affiliation(s)
  • MAUI MEMORIAL MEDICAL CENTER - (Acute Care)
    221 MAHALANI STREET
    WAILUKU, HI 96793
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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